Mechanical ventilation in the emergency department for 24 hours or longer is associated with delayed weaning

Abstract

PURPOSE: We examined various aspects of critical care to identify factors in the emergency department (ED) that affected the overall duration of mechanical ventilation (MV). We specifically focused on whether 24 hours of ED MV affected the weaning success and the duration of MV.

MATERIALS AND METHODS: Mechanical ventilation cases that started in the ED because of purely respiratory problems were enrolled in the retrospective cohort. We recorded demographic data, duration of MV in ED, various severity scores, previously known factors of prolonged MV, and achievement of ventilator weaning. All the significant factors in univariate survival analyses were included in a multivariate analysis.

RESULTS: The estimated median of the entire duration of MV was longer in patients who received 24 hours or more of MV in ED compared with that of patients who received MV for less than 24 hours (33.0 vs 15.4 days, P = .003). Mechanical ventilation for longer than 24 hours in the ED remained a significant factor that prolonged the entire MV duration in the multivariate analysis (hazard ratio, 0.577; P = .019). Hypoalbuminemia and abbreviated mortality in ED sepsis (MEDS) score were also independently correlated (P ≤ .001 for both).

CONCLUSIONS: Mechanical ventilation in the ED for 24 hours or longer is associated with delayed ventilator weaning.